Ear Disease and Surgery

Question 1

What factors can predispose to ear disease?

Answer 1

Abnormal ear conformation
Obstruction
Excessive moisture
Cornification disorders
Immunosuppression

Question 2

What can cause primary inflammation of the ear canal?

Answer 2

FBs
Parasites
Skin hypersensitivity 
Contact dermatitis
Immune-mediated
Miscellaneous

Question 3

What can cause secondary pathology to abnormal ears?

Answer 3

Staph intermedius
Pseudomonas
Proteus
Klebsiella
E. coli
Malassezia

Question 4

What factors can prevent resolution of otitis?

Answer 4

Ear canal pathology

Middle ear disease

Question 5

What are the two manifestations of otitis?

Answer 5

Chronic pruritic otitis externa

Chronic progressive purulent otitis

Question 6

How do chronic pruritic otitis externa and chronic progressive purulent otitis differ?

Answer 6

CPOE - Allergic skin disease, secondary infections, bilateral, all of canal, control of inflam required

CPPO - unresolved infection, multifactorial, soft tissue changes, otitis media

Question 7

What is otitis externa commonly associated with?

Answer 7

Otitis media

Question 8

Is the tympanum normally intact or broken in otitis media?

Answer 8

Intact

Question 9

What occurs when otitis progresses from an acute to chronic infection?

Answer 9

Microbial shift of G+ve and Malassezia to G-ve

Question 10

When is ear surgery indicated?

Answer 10

Tumours, polyps
Irreversible stenosis
Medical treatment has failed
Need for full investigation

Question 11

How is otitis managed medically?

Answer 11

Cleaning of the ear canal
Topical treatments of infections
Investigation of any underlying disease
Remove predisposing factors

Question 12

What do topical medicines for otitis contain?

Answer 12

Antifungal
Antibacterial
Glucocorticoid

Question 13

What are common causes of treatment failure of otitis?

Answer 13

Not long enough
Inadequate ear cleaning
Failure to identify otitis media and soft tissue changes
Failure to identify primary cause

Question 14

How is response to treatment of otitis monitored?

Answer 14

Cytology of ear swabs

Question 15

What are the possible adverse effect of otic medication?

Answer 15

AD
Nerve damage
Ototoxicity

Question 16

Taking cost, length of treatment and effectiveness against Malassezia, which are the ear cleaners of choice?

Answer 16

Osurnia

Surolan

Question 17

Why are Aurizon and Posatex unsuitable ear cleaners?

Answer 17

They both contain reserve ABs

Question 18

Why are Auroto and Canaural not always the ideal ear cleaners?

Answer 18

Have no action against Malassezia

Question 19

What agents may be used alongside water/saling when flushing the ear canal?

Answer 19

0.05% chlorhexidine
0.5% povidone-iodine
Acetic acid 5%

Question 20

What does the middle ear consist of?

Answer 20

Tympanum
Malleus, incus, stapes
Eustachian tube
Air filled, resp epithelium
Para (facial)/symp nerves

Question 21

What does the inner ear consist of?

Answer 21

Cochlea

Vestibulum

Question 22

Outline the pathogenesis of othaemtoma…

Answer 22

Otitis/allergy/FB/parasites => scratch and head shaking => fracture of auricular cartilage => fibrin deposition => contraction

Question 23

What are the clinical signs of othaematoma?

Answer 23

Otitis externa

Thickening of concave side

Question 24

How is othaematoma treated medically?

Answer 24

Aspiration, drainage

Pressure bandage

Question 25

How is othaematoma treated surgically?

Answer 25

1. S-shaped incision on concave side of pinna 2. Remove clots and fibrin 3. Flush 4. Close cavity with Monocryl 5. Protective bandage, collar, AB, analgesia

Question 26

What direction are sutures place in when closing a othaematoma wound?

Answer 26

Parallel to incision

Question 27

What are the possible complications of othaematoma removal?

Answer 27

Recurrence Cartilage degeneration and ossification Abcessation

Question 28

What are the indications for a pinnectomy?

Answer 28

``` Solar injury Neoplasia Trauma Vasculitis Frostbite Recurrent chondritis in cats Permanent marking ```

Question 29

What diagnostic tolls are used in assessing the ear canal and middle ear?

Answer 29

Hx and PE Otoscope Imaging

Question 30

What should be assessed on PE for ear canal/middle ear disease?

Answer 30

``` Posture and gait Position of head Facial nerve paralysis Horner's syndrome Skin problems Discolouration of paws ```

Question 31

How should otitis externa be treated before surgery?

Answer 31

Always manage medically

Question 32

What are surgical options for treating ear problems?

Answer 32

Lateral wall resection Vertical ear canal ablation TECA +/- lateral bulla osteotomy

Question 33

What are the indications for a lateral wall resection of the ear?

Answer 33

Local benign tumour Malignant tumour in skin V early otitis externa

Question 34

What are the indications for a vertical ear canal ablation?

Answer 34

Tumour of the vertical ear | Following separation of vertical and horizontal parts of ear canal

Question 35

What are the indications for a TECA with lateral bulla osteotomy?

Answer 35

``` Endstage otitis externa Persistent otitis externa Otitis media Para-aural abscessation Ear canal neoplasia Severe ear canal trauma ```

Question 36

What are the possible complications with a TECA and lateral bulla osteotomy?

Answer 36

``` Deafness Facial nerve paralysis Vestibular diease Haemorrhage Wound infection Wound breakdown Fistulation ```

Question 37

What is the most common complication of TECALBO in cats?

Answer 37

Damage to the facial nerve

Question 38

How can otitis media be treated?

Answer 38

Medical - myringotomy and AB | Surgery

Question 39

How is otitis media/interna diagnoised?

Answer 39

Otoscopy - red tympanum Radiography CT/MRI

Question 40

How can otitis media/interna be treated durgically in cats?

Answer 40

Ventral bulla osteotomy